Summary:

• 13 years of experience as Business/Requirement Analyst working in the health care sector.
• 10 years of experience in designing solutions for complex web-based business applications.
• Project Management Experience includes Waterfall model 7 years and Agile 5 years .
• Contributed to all levels of the user experience and in all phases of the product development lifecycle, from defining a product's overall architecture and structure, to iterating, specifying, and polishing the interaction details for specific features.
• Experience using user-centered design techniques, and creating high-quality deliverables that communicate the intended user experience.
• Experience working in collaboration with product development teams using Agile/Scrum and waterfall software methodologies.
• Assisted with EDI conversion from 4010 to 5010 and also assisted with mapping and crosswalk documentation and system testing.
• Within the Agile ideology, led JAD sessions to develop strategy, timelines, project deliverables and measurable and human resource and system requirements.
• Communicated with web developers in SCRUM meetings to ensure business requirements were concise and transparent to ensure clarity of system augmentations.
• Develops necessary documentation for SDLC checkpoints such as Design Review Board and Change control Understands and follows Agile work development for building data warehouse
• Work collaboratively with the system development team to ensure all data needed to meet department requirements are captured and accurately reflected in the 834, 835 and 837i 837p system interface, upload and output lifecycles.
• Supervised an Independence Blue Cross Validation Team 12 Associates investigated, analyzed, interpreted and managed routine information of providers associated with multiple networks.
• Created Business Requirements, Business Process Maps, Functional Requirements, Technical and Design Specifications.
• Created user cases, architecture and product requirements, wire diagrams and functional designs based on JAD sessions to create baselines for stakeholders overview and agreement.
• Business Lead User Acceptance Testing UAT
• Develop test plan.
• Develop database queries for extracting test data.
• Manual UAT test case development and execution.
• Requirements tracking and reporting.
• Documentation of test plan and test results.
• Maintaining testing artifacts and storing testing evidence.
• Develop a transition plan for providing testing managed services.

Technical Skills:

Power MHS, Irma-MainFrame, CIS, ITS, Planmate, SmartTerm Tingley , DISCORP, PBS, NASCO, Microsoft Outlook, Word, Access, Excel, PowerPoint, ITS, MicroStrategy Business Intelligence Tool , SAS Enterprise 9.2., CCMS, CIS, Cactus, UML, Visio, Methodologies Waterfall, Agile

Employment History:

Confidential

Responsibilities

• Collaborated with external and internal stakeholders to gather, analyze and document information needs and functional requirements for client based applications
• Translated business requirements in support of solution design and configuration
• Prepared functional designs of product customizations and features
• Project planning/execution: balance stakeholder expectations regarding the project scope/components, priorities, schedule, and manage risk to these components
• Assisted in determining quality standards, monitoring results, and implementing quality improvements
• Operated in a results-oriented manner to achieve projects goals, with a standard of excellence
• Provided input for the direction of product design and usability
• Produced and conduct internal training sessions on new product features and modules
• Responsible for drafting all required SDLC and validation documents and facilitating the review and approval of all project documentation.
• Determined the usability of existing code for inclusion in other applications
• Identify the strengths and weaknesses of various systems modules to determine if consolidation or elimination is necessary.
• Charged with creating user case realizations e.g. wireframes, sequence diagrams, and activity diagrams utilizing UML diagrams.

Confidential

Responsibilities

• Implemented and analyzed Power MHS system functions.
• Research business needs and recommend solutions to issues.
• Work with outside areas to understand business issues and coordinate resolutions through documenting work flows, or extracting reports to satisfy business requirements.
• Developed and test system changes to meet determined needs.
• Received prestigious Employee of the Month award for February, 2012.
• Created all existing Business Requirements, Business Process Maps, Functional Requirements, Technical and Design Specifications.
• Conducted interviews of client's application Subject Matter Experts and capture business and testing knowledge.
• Provided User Acceptance Testing UAT
• Developed test plan.
• Developed database queries for extracting test data.
• Manual UAT test case development and execution.
• Requirements tracking and reporting.
• Documentation of test plan and test results.
• Maintaining testing artifacts and storing testing evidence.
• Developed a transition plan for providing testing managed services.
• Created user cases, architecture and product requirements, wire diagrams and functional designs based on JAD sessions to create baselines for stakeholders overview and agreement utilizing UML modeling.
• Reviewed and evaluated incoming data and help design interfaces to Power MHS system.
• Reviewed and evaluated external data requirements and export appropriate data.
• Understand operational needs and help to design reports to satisfy requirements.
• Provided on-the-job system training and assistance to members of the business and Information Services community, on an as-needed basis.
• Drafted business specifications for IS projects and communicate between assigned technical staff and business unit for progress and resolution of issues.
• Understand data structures throughout both the transaction system and the data warehouse.
• Worked with data on a daily basis analyzing data, writing reports and queries and support other departments with their complex data needs.
• Communicated with technical resources at Vendors - Health First, Health Partners, Emdeon and EDI submitters to assist Management with facilitating test cycles and problem resolution.
• Coordinated system upgrades based on Business Requirements and system functionalities for user roles.
• Worked with the Project Manager as Operational Business Lead to schedule and track status of various ongoing testing initiatives.
• Worked closely in a team consisting of Solutions Architects, Data Warehouse Engineers, Business Analysts, System Analysts, Quality Assurance Engineers and Database Administrators in developing and executing data validation plans
• Within the Agile ideology I led JAD sessions to develop strategy, timelines, project deliverables and measurable and human resource requirements.
• Communicated with web developers in SCRUM meetings to ensure business requirements were concise and transparent to ensure clarity of system augmentations.
• Utilized the Agile model I worked with the Project Manager as Operational Business Lead to schedule and track status of various ongoing testing initiatives within project scope.
• Developed necessary documentation for SDLC checkpoints such as Design Review Board and Change control Understands and follows Agile work development for building data warehouse
• Served as a gatekeeper of technical quality assurance to validate that the technical environment is delivered as designed and meets all performance requirements Maintains test defect logs and manage defects until resolved.

Environment: Power MHS, Irma-MainFrame, CIS, ITS, Planmate, SmartTerm Tingley , DISCORP, PBS, NASCO, Microsoft Outlook, Word, Access, Excel, PowerPoint, MicroStrategy Business Intelligence Tool , SAS Enterprise 9.2., CCMS, CIS, Cactus.

Confidential

Responsibilities

• Assisted Project Lead/Management/Executive in developing and modifying tactical project plan s for Information Security.
• Completed routine project tasks in an accurate and timely manner in accordance with the established project plan.
• Acted in a cross-functional team environment establishing the relationships necessary to execute assigned tasks.
• Maintained awareness of changing business needs and impact of those changes on the assigned project.
• Gathered, reviewed and analyzed data, processes and requirements related to assigned project employing a variety of statistical and analytic techniques for claims, members and providers information.
• Developed necessary documentation for SDLC checkpoints such as Design Review Board and Change control Understands and follows Agile work development for building data warehouse
• Acted independently under the general direction of Project Lead/Management/Executive.
• Identified business process and/or technology problems and issues participate in the identification and documentation of solutions.
• Extracted information from PeopleSoft into MS Access and using this information as a reporting tool for upper management.
• PeopleSoft information was cross-referenced with IBC associates user security roles for all processing systems to create information security reports.
• Utilized the Agile model to interact with Project Manager as Business Systems Analyst to schedule and track status of various ongoing testing initiatives within project scope
• Transformed business strategies and tactical requests into functional and technical specifications.
• Produced project reports and summaries.
• Created user cases, architecture and product requirements, wire diagrams and functional designs based on JAD sessions to create baselines for stakeholders overview and agreement utilizing UML modeling.
• Created user test scenarios and test plans for Information Security.
• Supported multiple project tasks simultaneously.
• NASCO, Power MHS, and Irma-MainFrame benefits coding loaded in processing systems.
• Loaded newly credentialed providers into a customized database for Amerihealth, Pennsylvania, Delaware, New York, Florida, Texas and Maryland.

Environment: NASCO, Power MHS, and Irma-Mainframe

Confidential

Responsibilities

• Administered complex provider data changes.
• Reviewed all work for department for quality assurance.
• New data specialist trainer on all healthcare systems.
• Awarded prestigious Most Valuable Team Player for Network Data Admin for 2001.
• Interfaced with business client management to solicit streamlined requirements and drive issue resolution per individual analysis.
• I led a team of 12 validation analysts at Health Partners. The purpose of this project was to authenticate Provider data PCP and Specialists system configuration based on contract and business documentation. Types of data that was validated were demographic, W-2, fee schedules, hospital affiliations, medical credentials and diagnosis and procedure codes. The data that was certified in various networking system were pertinent to claims payment lifecycles because of ETL transactions, mapping and system crosswalks. The Provider data interface processes are vital to complete payment cycles that are governed by HMO provider contracts to guarantee customer satisfaction.
• Document outstanding issues into summary format for periodic communication to the User Group for prioritization and subsequently to Steering Committee and Project Sponsors for approval of priorities.
• Maintain the database of enhancement requests, issues and bugs, recording status, monitoring progress and acquiring user specifications
• Loaded newly credentialed providers into a customized database for Amerihealth, Pennsylvania, Delaware, New York, Florida, Texas and Maryland.
• Assisted Project Lead/Management/Executive in developing and modifying tactical project plan s for Information Security.
• Under general direction, formulated, analyzed and defined systems scope and objectives based on both user needs and a good understanding of applicable business systems and industry requirements.
• Maintains a database for all complete, incomplete and quality assurance paperwork.
• Responsible for drafting all required SDLC and validation documents and facilitating the review and approval of all project documentation.
• Contacted providers to ensure all demographic and personal information was current.
• Coordinated production with provider directories.
• Coordinate the activities from development through release with the various stakeholder groups, including QA signoffs, UAT testing, user training and documentation, and deployment planning
• Processed test scenarios for systems development specifically for MHS.
• Experience working with data models and data management including data integration and extraction technologies in association with implementing and configuring business processes.
• Organized and worked on special projects when assigned.
• Participate in the change management process overseeing the definition, approval, and implementation of scope changes.
• Assisted Supervisor and Manager with monthly department inventory reports.

Environment: Power MHS, Irma-MainFrame, CIS, ITS, Planmate, SmartTerm Tingley , DISCORP, PBS, NASCO, Microsoft Outlook, Word, Access, Excel, PowerPoint

Confidential

Responsibilities

• Administered complex provider data changes.
• Under general direction, formulated, analyzed and defined systems scope and objectives based on both user needs and a good understanding of applicable business systems and industry requirements.
• Reviewed all work for department for quality assurance.
• New data specialist trainer on all healthcare systems.
• Loaded newly credentialed providers into a customized database for Amerihealth, Pennsylvania, Delaware, New York, Florida, Texas and Maryland.
• Drafted all required SDLC and UAT/SIT validation documents.
• Reviewed test plans, test cases, and test scripts against requirements documentation to ensure full requirements-testing traceability.
• Maintains a database for all complete, incomplete and quality assurance paperwork.
• Contacted providers to ensure all demographic and personal information was current.
• Experience working with data models and data management including data integration and extraction technologies in association with implementing and configuring business processes.
• Coordinated production and QA'd all data within network directories.
• Coordinate the activities from development through release with the various stakeholder groups, including QA signoffs, UAT testing, user training and documentation, and deployment planning
• Processed test scenarios for systems development specifically for MHS.
• Work with the Business staff to produce comprehensive requirements and detailed specifications for existing and new system functionality, interfaces, and reports. Analyze enhancement requests, defects and other issues, translating them into professional specifications
• Organized and worked on special projects when assigned.
• Interfaced with business client management to solicit streamlined requirements and drive issue resolution per individual analysis.
• Participate in the change management process overseeing the definition, approval, and implementation of scope changes.
• Assist Supervisor and Manager with monthly department inventory reports.